Introduction: Ankle sprains remain the single most frequent injury in modern sports with increasing evidence that it is not as innocuous as previously thought. Conservative treatment options include various forms of immobilisation such as casts, moonboots and stirrup braces, followed by a rehabilitation period involving different modalities. Despite clinical evidence there seems to be a divergence between research and practice with an increase in acute surgical repair especially with regard to professional athletes. The aim of the study was to assess the approach on management of acute ankle sprains by orthopaedic surgeons in South Africa, by means of a descriptive cross-sectional survey analysis. Methods: This was a two-part study. First, a questionnaire was emailed to participating orthopaedic surgeons, consisting of eight treatment options for a grade three lateral ankle sprain in a non-professional athlete. Secondly, a literature review was undertaken to establish the current best practice concerning ankle sprain management. Results: A total of 129 responses was received out of the 719 that were sent out. Surgical repair was offered in 24 (19%). Conservative treatment including either cast or moonboot for a period of six weeks was chosen by 49 (38%) and two to four weeks by 55 (43%) as their preferred treatment. Only 39 (30%) of responding South African Orthopaedic Association members chose a short period of immobilisation followed by functional rehabilitation in accordance with the current best evidence available, based on the literature review done. Conclusion: Despite good clinical evidence, there seems to be a lack of consensus in the management of grade three lateral ankle sprains.
Introduction Institutions are increasingly using technology to augment the class learning experience of medical students. Especially in Africa, local content is key to allow insights and knowledge to emerge and build transformative capacity for students and patients. There is currently no peer-reviewed video content produced to provide insight into Orthopaedic conditions for medical students and patients in this region. Our goal was to evaluate the demographic and geographic viewership as well as video-specific statistics of orthopaedic teaching videos for medical students on a YouTube channel, with the expressed aim of informing future content production. Methods Videos were produced by local medical students for their in problem-based collaborative projects. Student-owned smartphones and various free video editing software were used to produce these videos, which were then assessed by a group of orthopaedic specialists and uploaded onto a Youtube channel (UCTeach). The analytic reports of this channel generated by Google and YouTube were analysed regarding watch time per day (minutes), average view duration (minutes), most watched videos, top geographies, age, and gender. Results A total of 83 videos of the UCTeachOrtho Channel where uploaded in a two year period with a total watch time of 857 062 minutes and 337 983 views. The majority of viewers where between the ages 18 and 34 years (85%). India had the most views (n=69,089) followed by the United States (n=66,257) and South Africa (n=21,882). Most of the videos where watched on mobile phones (n= 183,299) and computers (n=128,228). The most watched video was produced in April 2016 on physiological and pathological gait with 51,314 views. Conclusion Our study highlights that a low-cost collaborative video project can lead to high view counts and watch time on YouTube, and is accessible to an audience in low and middle income countries. Student-centred local content in orthopaedic surgery also reached a global audience consistently over a two-year period.
Background: Posterior malleolus fractures are associated with poorer functional outcomes compared to simpler malleolar fractures. Traditional teaching states that if a posterior malleolus fracture involves less than 25% of the distal tibia, it can be managed without fixation. Current literature has shown that fixation should not be based on the size of the posterior fragment but rather on the fracture pattern, instability and awareness that reduction and fixation is biomechanically advantageous. We hypothesised that current management of ankle fractures with posterior malleolus involvement in South Africa is not evidence-based and is suboptimal. We sought to assess the training, experience and decision-making of surgeons and trainees who are involved in the management of ankle fractures. Another aim was to develop evidence-based algorithms for the management of posterior malleolus and complex ankle fractures. Methods: An email survey consisting of questions related to the management of ankle fractures was sent to specialists, registrars and medical officers who voluntarily completed an online survey. Results: A total of 103 out of 456 emails sent drew responses to the survey. Responses included 28% from consultants, 54% from registrars and 18% from medical officers. Forty-six per cent of responders believed that posterior malleolus fractures can be managed non-operatively if less than 20% of the tibial plafond is involved. Only 49% would CT scan a posterior malleolus prior to operating. Thirty-eight per cent of the responders were not familiar or comfortable with the posterior-lateral approach used for fixation of the posterior malleolus directly. Conclusion: Understanding of ankle fractures has progressed. A significant proportion of responders to the survey are not following best practice and current literature. Posterior malleolus fractures are not benign and have poorer outcomes compared to bi-malleolar or lateral malleolus ankle fractures. All patients with posterior malleolus fractures should receive pre-operative CT scan. All posterior malleolar fractures that can be held with a plate or screws should be fixed.
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